AT FIRST YOU WILL NOT SUCCEED: NEGOTIATING FOR CARE IN THE CONTEXT OF HEALTH REFORM

In the majority of the literature on the social organization of care work, care is often defined in more traditional terms to refer to work on or directly related to the body. In this paper, we would like to venture beyond the body to elaborate upon a particular type of care work – negotiating care – that involves negotiations and sometimes petitions for the purpose of securing care. It is a concept that was salient in a comparative study of the experiences of health care providers with the increasing management of health care in Canada and the United States. For physicians and nurses in both settings we find a sense of the increasing burden of negotiating for care for patients – particularly textually mediated negotiations – as the access to and amount of care is increasingly limited through managed care policies. Moreover, the contexts for these negotiations are continually in flux exacerbating the time devoted to negotiate care. It is in the U.S. context, however, that textual negotiation of care is most extensive and differs in terms of audience – insurers as opposed to providers – and purpose – securing payment and not just care.